Antimicrobial resistance surveillance: a crucial pillar for sustainable leprosy control and chemoprophylaxis.

Leprosy, also known as Hansen´s disease, remains a public health concern, with around 200 000 new cases reported worldwide each year. Recent strategies to reduce transmission include post-exposure prophylaxis (PEP) with single-dose rifampicin, which has shown moderate protective efficacy and is being increasingly implemented on scale. However, widespread rifampicin use outside combination therapy raises concerns regarding the potential emergence of antimicrobial resistance (AMR) in Mycobacterium leprae and Mycobacterium tuberculosis. Although AMR in leprosy is less common than that in tuberculosis, resistance to rifampicin, dapsone, and fluoroquinolones highlights the need for systematic surveillance. However, AMR surveillance remains inconsistently implemented, with inadequate laboratory capacity, insufficient political prioritisation, and fragmented global coordination posing major barriers. In this Personal View, we argue that AMR surveillance should be an integral component of leprosy control and PEP programmes. We outline key challenges and propose pragmatic policy recommendations, including strengthening laboratory capacity, integrating surveillance into national programmes, and leveraging existing tuberculosis diagnostic networks. Embedding AMR surveillance within PEP strategies supports the long-term effectiveness of treatment and prevention efforts while minimising unintended consequences for global health.